title: Different recommendations for empiric first-choice antibiotic treatment of uncomplicated urinary tract infections in Europe.
abstract: OBJECTIVE
  Uncomplicated urinary tract infection (uUTI) is a common reason for antibiotic treatment in primary health care. Due to the increasing prevalence of antibiotic-resistant uropathogens it is crucial to use the most appropriate antibiotics for first-choice empiric treatment of uUTI. Particularly, it is important to avoid antibiotics associated with a high rate of antimicrobial resistance. This study compares national recommendations from six European countries, investigating recommendations for first-choice antibiotic therapy of uUTI.
  
  
  METHODS
  General practice in six European countries.
  
  
  METHODS
  Searches were undertaken on PubMed, the Cochrane Library databases, Google, and Google Scholar. Recommendations from different geographical regions in Europe were investigated: Northern Europe (Denmark, Sweden), Western Europe (Scotland), Central Europe (Germany), Southern Europe (Spain), and Eastern Europe (Croatia).
  
  
  RESULTS
  The six countries recommended seven different antibiotics. Five countries recommended more than one antibiotic as first-choice treatment. Half of the countries recommended antibiotics associated with a high rate (> 10-20%) of resistant E. coli. All countries recommended at least one antibiotic associated with a low (< 5%) resistance rate.
  
  
  CONCLUSIONS
  The differences in first-choice treatment of uUTI could not be explained by differences in local bacterial aetiology or by different patterns of antimicrobial resistance. Despite resistance rates exceeding 10-20%, sulphamethizole, trimethoprim. or fluoroquinolones were recommended in half of the countries.
  
  
  CONCLUSIONS
  Within the European countries there are considerable differences in recommendations for empiric first-choice antibiotic treatment of uUTI. In order to reduce the increasing antimicrobial resistance in Europe, it is important to agree on the most appropriate antibiotics for empiric treatment of uUTI.
authors.affiliation: Section and Research Unit of General Practice, Department of Public Health, University of Copenhagen , Denmark.
authors.forename: Josephine
authors.initials: J
authors.lastname: McQuiston Haslund
authors.forename: Marianne
authors.initials: M
authors.lastname: Rosborg Dinesen
authors.forename: Anni Brit
authors.initials: AB
authors.lastname: Sternhagen Nielsen
authors.forename: Carl
authors.initials: C
authors.lastname: Llor
authors.forename: Lars
authors.initials: L
authors.lastname: Bjerrum
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D024881:Drug Resistance, Bacterial; D005060:Europe; D006801:Humans; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care; D014552:Urinary Tract Infections / Q000188:drug therapy*
chemical_list: D000900:Anti-Bacterial Agents